Borderline personality disorder (BPD) has been recognized by the American Psychiatric Association (APA) as a distinct mental health condition for more than 40 years. But many experts believe that the time as come for rethinking borderline personality, with the goal of classifying the disorder more appropriately and improving clinicians’ ability to treat it more effectively.
What is BPD?
Borderline personality disorder is a complex mental health condition that is characterized by emotional instability and impulsivity.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must meet at least five of the following nine criteria to be diagnosed with BPD:
- Frantic efforts to avoid being abandoned (including both real and imagined abandonment)
- Engaging in a pattern of intense but unstable relationships
- Persistent instability in self-image or sense of self
- Impulsivity in at least two potentially harmful areas, such as sex, spending, substance abuse, and binge eating
- Recurring self-harm, suicidal ideation, and/or suicidal behaviors
- Brief but intense episodes of irritability, anxiety, dysphoria, or other extreme moods
- Chronic sense of emptiness
- Difficulty controlling or managing anger
- Paranoia and/or dissociation
Experts estimate that borderline personality disorder affects around 1.6% of the population. With the current U.S. population of about 330 million, this means that approximately 5.2 million Americans may have BPD.
Among people who have received inpatient psychiatric care, borderline personality disorder is much more common. About 20% of people in this population have BPD.
Why It’s Time to Rethink Borderline Personality Disorder
As noted in the introduction to this page, some experts have called for rethinking borderline personality disorder.
The discussion about this topic includes debate over whether BPD should continue to exist as distinct mental health diagnosis, if the disorder should be renamed, or if its symptoms should be categorized differently.
Misconceptions
According to trauma expert Janina Fisher, PhD, one of the main reasons for rethinking borderline personality disorder is the misperception that BPD and trauma are unrelated.
“There is research going back to 1989 that correlates the diagnosis of borderline personality disorder with a history of childhood trauma, and that research has been more consistent than most research. Those studies have been replicated numerous times, and it’s almost as if the field has a blind spot,” Fisher said in an interview on the PESI website.
“No one ever remembers that this is clearly a trauma-related diagnosis, so we don’t treat borderline personality disorder as a trauma-related disorder,” she added. “We treat it as a personality disorder.”
Even among clients who have BPD, Fisher told PESI, many do not realize that they have been impacted by trauma. Clearing up this misperception, she noted, can lead to more appropriate therapeutic approaches and improved treatment outcomes.
Truth about BPD
In a January 2022 article about rethinking borderline personality disorder on the Scientific American website, writer Diana Kwon reported that as many as 80% of people with BPD may have a history of trauma. She also stated that many people (including both clinicians and patients) have advocated on behalf of renaming BPD as complex posttraumatic stress disorder, or CPTSD.
Martin Bohus, a psychiatrist at the Central Institute for Mental Health in Mannheim, Germany, told Kwon that viewing borderline personality disorder through a trauma-informed lens is a more appropriate way to address the challenges that people who are now diagnosed with BPD are facing.
“[BPD] fits much better to stress-related disorders because what we know from our clients is that there is no borderline disorder without severe, interpersonal early stress,” Bohus said.
No “official” reclassification of borderline personality disorder as complex PTSD or another condition will occur at least until a new version of the DSM is published. BPD was first included in the third edition of the DSM, and it remained in this resource book in its fourth and fifth editions.
The DSM-3 was published in 1980. The DSM-4 came out in 1994, and the current edition (DSM-5) made its initial appearance in 2013. An updated version of the DSM-5 was released in March 2022. This version, DSM-5-TR, did not include any changes related to BPD’s diagnostic criteria or classification.
How to Properly Help Someone With Symptoms of Borderline Personality Disorder
Though the issue of rethinking borderline personality disorder may be controversial to some people, there is little debate about the necessity of treatment for people who experience the symptoms that are currently associated with BPD.
Comprehensive treatment for borderline personality disorder typically involves one or more types of psychotherapy.
Dialectical behavior therapy (DBT) is the leading form of therapy for borderline personality disorder. This approach, which was established by Dr. Marsha Linehan near the end of the previous century, focuses on skill development in four areas:
- Core mindfulness
- Emotion regulation
- Distress tolerance
- Interpersonal effectiveness
DBT also addresses parasuicide, trauma, and behaviors that diminish self-respect and undermine the therapeutic process.
If a person with BPD is also dealing with depression, anxiety, trauma, or other co-occurring mental health concerns, treatment may include elements such as transcranial magnetic stimulation (TMS) therapy, eye movement desensitization and reprocessing (EMDR) therapy, neurofeedback, somatic therapy, and various prescription medications.
Begin Treatment for Borderline Personality Disorder in Los Angeles, California
Montare Behavioral Health is a premier provider of comprehensive treatment services for adults whose lives have been disrupted by borderline personality disorder, trauma, and a wide range of additional mental health concerns. At our treatment center in Los Angeles, California, skilled professionals offer focused inpatient and outpatient care in a safe and extremely supportive environment. Contact us today to learn more.
